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General NPI Number Information
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NPI Number | 1245957604
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Entity Type | Organization
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Legal Business Name | GROUP 1 ORTHODONTICS, LLC
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Dates
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Enumeration Date | 10/25/2022
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 1350 SPRING ST NW
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City | ATLANTA
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State | GA
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Zip | 30309-2864
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Country | US
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Telephone | 770-648-1082
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Fax |
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Provider Business Mailing Address
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Address Line | 23 OLDE VILLAGE DR
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City | SALEM
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State | MA
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Zip | 01970-1782
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Country | US
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Telephone | 617-909-5459
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ DENTIST
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Name | DR. THEODORE MARKOS
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Credential | DMD
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Telephone | 617-909-5459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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